Provider Demographics
NPI:1750509543
Name:OVALLE ABUABARA, MONICA YAMILE (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:YAMILE
Last Name:OVALLE ABUABARA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:3565 W JOHNSON RD
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8577
Mailing Address - Country:US
Mailing Address - Phone:219-326-8883
Mailing Address - Fax:219-326-8882
Practice Address - Street 1:1300 STATE ST
Practice Address - Street 2:SUITE 2 F
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3185
Practice Address - Country:US
Practice Address - Phone:219-326-8883
Practice Address - Fax:219-326-8882
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01051098A208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice